PSVT Update (for science and researchers)

Gloaming: Thank you.

In good faith, I asked the moderator to let us start fresh:

“” Moderator: Please note that Gloaming has made a nice gesture and I also may have said too much . Can you please erase all our back-and-forth comments that follow my original post? In that way the post thread can start fresh? Thank you.””

Perhaps a medical prescription for more vacations would be recommended? It does appear to me that, even though I am 77, the daily life mundane aggravations influence my PSVT. My recent vacation eliminated all stress and PSVT vanished! Ha.

I've lived with PSVT for over 40 years, since I was 30. For a while I was keeping track of when I'd have an episode & how long it took me to "reset" the rhythm with various vagus-related maneuvers. During most of those years, I'd have an episode at most two or three times a year; sometimes a couple years would go by with no episodes. In recent years, it seemed my heart could more easily, or more often, start a PSVT episode, then just as easily drop back out. So that was different, but I was still pretty confident of my ability to control it and didn't give it a lot of thought. About a year ago, during an extra-stressful period, I was awakened by my heart pounding double-time. I'd never had PSVT while sleeping before, and I'd never had a "pounding" PSVT before. Anyway, I couldn't slow it down, went to the ER, got some adenosine or cardizem, and that was that. But, I was finally convinced to try some medication and was prescribed metoprolol.

The metoprolol "calmed" my heart, so I didn't get the quick starting & stopping of PSVT episodes, which was nice. The down side though was it seemed like once an episode did start, it was "locked in" and not going to respond to any efforts to reset it. So, over a period of about six months, I made two more trips to the ER for adenosine or cardizem! Easy enough to do, but I didn't want to keep doing it. I read something online about how metoprolol increases the vagal "tone" or activity level (thus that "calming" feeling I had), but in doing so, it raises the threshold of vagal maneuvering required to reset an episode once it starts. Something like that. Anyway, I wondered if there was some other medication that would help in some way other than by increasing the vagal activity level, and asked my cardiologist about that. He suggested continuing with the metoprolol and asked if I would be comfortable with, if an episode started, taking an inderal to help with the vagal maneuvers. I said yes, I would give that a try, and he gave me a prescription for that. (Meanwhile, I also cut out caffeine -- no coffee, no diet coke, no black tea -- and had already cut out alcohol, another sometimes-trigger for me.)

So that's where I am. So far, so good. I've also learned a new approach -- "anticipating" a possible episode, usually based on a quick beat or two that feels like my heart is "thinking" about launching into an episode, and taking an inderal then. No new episodes yet, but it's only been three months. So we'll see!

I had same Hx, but my SVT started ant ange 19 and at 57 I had it for 4 hours before went to ER. Before that it usually lasted seconds to a minute or two. I do have a few really fast flutters that even made me dizzy; that wasn’t a good sign, They gave me IV Adenosine in the ER which was scary. Stopped my heart beat literally! I saw my heart flatline for a couple seconds and felt the feeling of “ Impending Doom” as they say! Thank God it came back to Normal Sinus rhythm within seconds. I tried metoprolol after that and had all the Cardiac test possible and all checked out. On the Metoprolol it dropped my BP very low. I already have low BP. So since I couldn’t tolerate the Beta Blocker I had to have a Cardiac Ablation and they burned the spot in my right atrium that was causing the PSVT. It’s like a Cardiac Cath under anesthesia of course. I’ve been fine ever since. I enjoy my cofffee every morning and my Diet Coke when I eat out. Only suggestion regarding meds is maybe taking a magnesium supplement. Talk to your Dr about that. There are different forms of it.

@bb03 That's great to hear. I've thought about the ablation but so far haven't been able to bring myself to go forward with it as long as there seem to be alternatives that work for me. If I continue to have episodes I can't resolve on my own, that may change, though.

I do take magnesium. Is the ablation basically done in a hospital outpatient setting?

@lynndee227 Ablation is day surgery. It is painless, maybe a little discomfort at the incision site in the thigh, close to the groin, but that should pass inside of a couple of days. I have had two ablations. The first didn't work, but the second did, and I am free of atrial fibrillation for three years. Ablation is now considered to be the gold standard of care because it buys the heart time by being in normal sinus....functioning as intended, so you only get the normal heart aging. It's a bit more complicated because arrhythmias tend to be progressive....they get worse over time IF left unmanaged.

Thank you! Very helpful information. I think PSVT may be different from a-fib in regard to being progressive. At any rate, I've never heard that and I think my doctor would've mentioned it. But I will definitely ask. The description of the procedure is very helpful. So thank you especially for that.

@lynndee227 True, SVT is not considered to be progressive, but many arrhythmias are. The medical community tends to be conservative and will treat arrhythmias conservatively, which is reasonable. This usually means a trial of medications and lifestyle changes if they are sensible. If they work well, then great. If they don't, then ablations or pacemakers tend to come to the fore, and this is only if the patient complains of feeling unwell and not having a good quality of life (sensations, poor sleep, anxiety, etc).

Yes a hospital outpatient setting in case you don’t convert to a normal Sinus rhythm or worse a perforation of the catheter or a lethal cardiac rhythm occurs. You are under anesthesia also and it has its risks. No surgery or medical procedure is without risks. I trusted my Cardiologist/electrophysiologist, and everything went well, like textbook.